Bile composition and osmolarity in the interpretation of formation of bile stones and their classification

✍ Scribed by Ch. Chaimoff; R. Menache

• Publisher: John Wiley and Sons
• Year: 1979
• Tongue: English
• Weight: 194 KB
• Volume: 66
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800660707

✦ Synopsis

Summary

We studied the bile and gallstone composition of 38 surgical patients. According to their composition, the stones were classified as: 1, cholesterol stones, when they have more than 60 per cent cholesterol, or 2, pigment or pigment-mixed stones, when they have more than 40 per cent pigments (including stones with more than 30 per cent calcium). In the cholesterol-stone-forming group (24 cases) a ‘supersaturation’ in the cholesterol component of the bile and a concomitant reduction in bile salts was found. No such bile supersaturation was found in those with pigment or pigment-mixed stones (14 cases), or in the control group (8 cases).

The osmolarity of bile in patients with pigment or pigment-mixed stones is significantly higher than in those with cholesterol stones or in controls.

These results suggest a different mechanism for gallstone formation in the two groups: a ‘supersaturation’ of cholesterol with respect to bile salts and phospholipids in the formation of cholesterol stones and an ‘overconcentration’ of all bile components as a whole in the formation of pigment stones.

In an attempt to clarify the aetiology of gallstone formation, we measured in the bile of patients operated on for cholelithiasis the following parameters: cholesterol, bile salts, phospholipids and, for the first time, osmolarity. Chemical analysis of the gallstones was conducted to ascertain the content of cholesterol, pigments and calcium salts. We report the results of our study and the conclusions we have drawn.